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Kelley R, Bir S. Carotid atherosclerotic disease: A systematic review of pathogenesis and management. Brain Circ 2022; 8:127-136. [PMID: 36267431 PMCID: PMC9578307 DOI: 10.4103/bc.bc_36_22] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/12/2022] Open
Abstract
Carotid stenosis is an important contributor to ischemic stroke risk with resultant significant impact on neurological disability and death in adults and with worldwide implications. Management of carotid stenosis is impacted by whether there are associated symptoms along with the degree of stenosis. Understanding of the pathogenesis of carotid atherosclerosis or stenosis is important in management of carotid stenosis. Atherosclerotic plaque formation is a chronic insidious process with a number of potential contributors to the formation of such a plaque. The definition of atherosclerosis is not simply limited to abnormal deposition of lipid but also includes a chronic, complex, inflammatory process. Molecularly, in atherosclerosis, there is decreasing nitric oxide (NO) bioavailability, activity and/or expression of endothelial NO synthase, or increasing degradation of NO secondary to enhanced superoxide production. These above changes cause endothelial dysfunction leading to formation of foam cell followed by formation on lipid plaque. After lipid plaque formation, stable or unstable atherosclerotic plaque is formed depending on the calcium deposition over the lipid plaque. It continues to be clearly established that carotid intervention for symptomatic high-grade carotid stenosis is best managed with intervention either by carotid endarterectomy or carotid stenting. However, asymptomatic carotid stenosis is the subject of considerable controversy in terms of optimal management. This review of carotid atherosclerosis is an attempt to incorporate the information provided by more recent studies on pathogenesis and management which may help in the decision-making process for optimal management for protection against stroke.
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Computer aided diagnosis of Coronary Artery Disease, Myocardial Infarction and carotid atherosclerosis using ultrasound images: A review. Phys Med 2017; 33:1-15. [DOI: 10.1016/j.ejmp.2016.12.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/21/2016] [Accepted: 12/04/2016] [Indexed: 02/08/2023] Open
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Chiu B, Shamdasani V, Entrekin R, Yuan C, Kerwin WS. Characterization of carotid plaques on 3-dimensional ultrasound imaging by registration with multicontrast magnetic resonance imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1567-1580. [PMID: 23011620 DOI: 10.7863/jum.2012.31.10.1567] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The ability of magnetic resonance imaging (MRI) in carotid plaque component identification has been well established. However, compared to the costly nature of MRI, 3-dimensional (3D) ultrasound imaging is a more cost-effective assessment tool. Thus, an attractive alternative for carotid disease monitoring would be to establish a strategy in which 3D ultrasound imaging is used as a screening tool that precedes MRI. To develop and validate such a protocol, registration between ultrasound and MR images is required. This article introduces a surface-based algorithm for efficient ultrasound imaging-MRI registration. METHODS A surface-based 3D iterative closest point registration method was developed to align surfaces reconstructed from outer wall boundaries segmented from 3D ultrasound and MR images. The 3D ultrasound image was transformed according to the registration result and resliced to match corresponding 2-dimensional transverse MR images. Although rigid iterative closest point registration was used, the cross-sectional ultrasound images produced by the reslicing procedure can be moved relative to the MR images by an expert observer using in-house software, making nonrigid registration possible. RESULTS We evaluated the registration accuracy associated with the algorithm using a vascular phantom as well as in vivo ultrasound and MR images. Our registration method was shown to have an average error of 0.3 mm in the phantom study and less than 1 mm in the in vivo study. Our findings in terms of the average intensity of each component are consistent with histologically validated results described in previous ultrasound characterization studies. CONCLUSIONS We have developed a surface-based algorithm capable of registering ultrasound and MR images with high accuracy. This registration tool will potentially play an important role in a cost-effective screening protocol in which ultrasound is used to identify patients with a suspicion of vulnerable plaques, who are then further studied with MRI.
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Affiliation(s)
- Bernard Chiu
- Department of Electronic Engineering, City University of Hong Kong, 83 Tat Chee Ave, Kowloon, Hong Kong.
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Giannakopoulos T, Moulakakis K, Sfyroeras G, Avgerinos E, Antonopoulos C, Kakisis J, Karakitsos P, Brountzos E, Liapis C. Association between Plaque Echogenicity and Embolic Material Captured in Filter during Protected Carotid Angioplasty and Stenting. Eur J Vasc Endovasc Surg 2012; 43:627-31. [DOI: 10.1016/j.ejvs.2012.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 03/05/2012] [Indexed: 11/15/2022]
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Mughal MM, Khan MK, DeMarco JK, Majid A, Shamoun F, Abela GS. Symptomatic and asymptomatic carotid artery plaque. Expert Rev Cardiovasc Ther 2012; 9:1315-30. [PMID: 21985544 DOI: 10.1586/erc.11.120] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Carotid atherosclerotic plaques represent both stable and unstable atheromatous lesions. Atherosclerotic plaques that are prone to rupture owing to their intrinsic composition such as a large lipid core, thin fibrous cap and intraplaque hemorrhage are associated with subsequent thromboembolic ischemic events. At least 15-20% of all ischemic strokes are attributable to carotid artery atherosclerosis. Characterization of plaques may enhance the understanding of natural history and ultimately the treatment of atherosclerotic disease. MRI of carotid plaque and embolic signals during transcranial Doppler have identified features beyond luminal stenosis that are predictive of future transient ischemic attacks and stroke. The value of specific therapies to prevent stroke in symptomatic and asymptomatic patients with severe carotid artery stenosis are the subject of current research and analysis of recently published clinical trials that are discussed in this article.
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Affiliation(s)
- Majid M Mughal
- Department of Medicine, Division of Cardiology, Michigan State University, 138 Service Road, B208 Clinical Center, East Lansing, MI 48824, USA
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Baroncini LAV, Filho Pazin A, Murta LO, Nakao LS, Ramos SG, Précoma DB. Videodensitometric analysis of advanced carotid plaque: correlation with MMP-9 and TIMP-1 expression. Cardiovasc Ultrasound 2011; 9:24. [PMID: 21923935 PMCID: PMC3182957 DOI: 10.1186/1476-7120-9-24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 09/18/2011] [Indexed: 11/10/2022] Open
Abstract
Background Matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of MMP (TIMP) promote derangement of the extracellular matrix, which is ultimately reflected in plaque images seen on ultrasound. Videodensitometry can identify structural disturbances in plaques. Objectives To establish the correlations between values determined using videodensitometry in B-mode ultrasound images of advanced carotid plaques and the total expression of MMP-9 and TIMP-1 in these removed plaques. Methods Thirty patients underwent ultrasonic tissue characterization of carotid plaques before surgery, using mean gray level (MGL), energy, entropy and homogeneity. Each patient was assigned preoperatively to one of 2 groups: group I, symptomatic patients (n = 16; 12 males; mean age 66.7 ± 6.8 years), and group II, asymptomatic patients (n = 14; 8 males; mean age 67.6 ± 6.81 years). Tissue specimens were analyzed for MMP-9 and TIMP-1 expression. Nine carotid arteries were used as normal tissue controls. Results MMP-9 expression levels were elevated in group II and in normal tissues compared to group I (p < 0.001). TIMP-1 levels were higher in group II than in group I, and significantly higher in normal tissues than in group I (p = 0.039). The MGL was higher in group II compared to group I (p = 0.038). Energy had greater values in group II compared to group I (p = 0.02). There were no differences between patient groups in homogeneity and entropy. Energy positively correlated with MMP-9 and TIMP-1 expression (p = 0.012 and p = 0.031 respectively). Homogeneity positively correlated with MMP-9 and TIMP-1 expression (p = 0.034 and p = 0.047 respectively). There were no correlations between protein expression and MGL or entropy. Conclusions Videodensitometric computer analysis of ultrasound scanning images can be used to identify stable carotid plaques, which have higher total expression levels of MMP-9 and TIMP-1 than unstable plaques.
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Affiliation(s)
- Liz Andréa V Baroncini
- Department of Health and Scienses - Pontificia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Curitiba, Paraná, CEP: 80215901, Brazil.
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Daneshvar SA, Naqvi TZ. Carotid intima-media thickness and carotid plaques in cardiovascular risk assessment. CURRENT CARDIOVASCULAR RISK REPORTS 2009. [DOI: 10.1007/s12170-009-0020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Plaque volume compression ratio, a novel biomechanical index, is independently associated with ischemic cerebrovascular events. J Hypertens 2009; 27:348-56. [DOI: 10.1097/hjh.0b013e3283193e50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Kozakova M, Palombo C, Paterni M, Anderwald CH, Konrad T, Colgan MP, Flyvbjerg A, Dekker J. Body composition and common carotid artery remodeling in a healthy population. J Clin Endocrinol Metab 2008; 93:3325-32. [PMID: 18593775 DOI: 10.1210/jc.2007-2484] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT An independent association between obesity and preclinical carotid atherosclerosis has been demonstrated, however, the pathophysiological links were not clearly established. Body composition (BC) influences systemic hemodynamics and may participate in the remodeling of common carotid artery (CCA), independently of risk factors. OBJECTIVE This study evaluated the association between CCA structure and BC in a large population of healthy subjects. DESIGN This was a cross-sectional study. SETTINGS The study was conducted at 19 European centers. SUBJECTS The study included 627 healthy subjects (252 men, age 30-60 yr, body mass index 17-40 kg/m2). MAIN OUTCOME MEASURES CCA luminal diameter and intima-media thickness were measured on digitized ultrasound images. Acoustic properties of CCA wall were evaluated by digital densitometric analysis and described in terms of mean gray level. BC was assessed by electrical bioimpedance. Insulin sensitivity (euglycemic hyperinsulinemic clamp) and plasma adiponectin levels were measured. Associations between CCA structure, age, BC, and metabolic and atherosclerotic risk factors were analyzed by multivariate regression models. RESULTS Independent factors affecting CCA diameter were fat-free mass and waist girth (standardized r = 0.44 and 0.12; P < 0.01 and < 0.0001; R2 = 0.35); independent correlates of intima-media thickness were age, CCA diameter, systolic blood pressure, and low-density lipoprotein-cholesterol (standardized r = 0.39, 0.25, 0.10, and 0.14; P < 0.005-0.0001; R2 = 0.40). The mean gray level of carotid wall was independently associated with age and waist girth (standardized r = 0.23 and 0.12; P < 0.0001 and = 0.001; R2 = 0.30). CONCLUSIONS Findings of this cross-sectional study suggest that BC modulates CCA diameter, and may induce adaptive changes in carotid wall thickness, independently of metabolic and atherosclerotic factors. Central adiposity modifies the acoustic properties of carotid wall.
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Affiliation(s)
- Michaela Kozakova
- Department of Internal Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy.
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Baroncini LAV, Filho AP, Ramos SG, Martins AR, Murta LO. Histological composition and progression of carotid plaque. Thromb J 2007; 5:4. [PMID: 17324272 PMCID: PMC1808443 DOI: 10.1186/1477-9560-5-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Accepted: 02/26/2007] [Indexed: 12/02/2022] Open
Abstract
Background To analyse histological composition and progression of carotid plaque. Methods Thirty-one patients (22 males, mean age 68.03 ± 7.3 years) admitted for carotid endarterectomy for extracranial high-grade internal carotid artery stenosis (≥ 70% luminal narrowing) were enrolled. The patients were divided into 2 groups according to symptomatology (group I, 17 symptomatic patients; and group II, 14 asymptomatic patients). A histological analysis and inflammatory cell quantification of each excised carotid plaque was made. Nine carotid arteries were removed from human cadavers that were not preselected for carotid artery disease. These specimens were used as a control tissue without any macroscopic signs of atherosclerotic plaques. Results Fifty eight percent of all carotid plaques were classified as complex plaque with possible surface defect, hemorrhage or thrombus. The inflammatory cells concentration did not differ between the two groups. All specimens from human cadavers were classified as preatheroma with extracellular lipid pools. Conclusion Asymptomatic and symptomatic patients could have the same histological components on their carotid plaques. Fibrotic and calcific plaques could become vulnerable as complex plaques with surface defect, hemorrhage and thrombus could remain silent. Asymptomatic carotid stenosis should be followed close with no invasive diagnostic methods and clinical evaluation.
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Affiliation(s)
- Liz Andréa Villela Baroncini
- Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Antonio Pazin Filho
- Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Simone Gusmão Ramos
- Department of Pathology, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Antonio Roberto Martins
- Department of Pharmacology, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Luiz Otavio Murta
- Department of Physics and Math, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Onozuka H, Muraki M, Mikami T, Yoshimoto T, Yoshizumi T, Kitaguchi M, Sugawara T, Tokuda K, Kaneko S, Kashiwaba T, Yamada S, Tsutsui H, Kitabatake A. Prevalence and clinical importance of spontaneous echo contrast within the carotid artery in patients with ischemic cerebrovascular disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:169-77. [PMID: 17255178 DOI: 10.7863/jum.2007.26.2.169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Spontaneous echo contrast (SEC) is composed of numerous microechoes swirling in the cardiovascular lumen, usually appearing during blood stasis. This study aimed to clarify the clinical importance of SEC in the carotid artery (CA) in patients with ischemic cerebrovascular disease (ICVD). METHODS In 264 CAs of 132 consecutive patients with ICVD and in 40 CAs of 20 healthy control subjects, SEC was classified as none, faint, or dense, and CA abnormalities, including plaque, plaque ulcer, mural thrombus, and internal CA stenosis, were assessed with 10-MHz sonography. RESULTS The overall prevalence of SEC was greater in CAs of patients with ICVD (164/264 [62%]) than in CAs of control subjects (6/40 [15%]; P < .0001). Dense SEC was more specifically detected in CAs of ICVD with the prevalence of 81 (31%) of 264, which was greater than that of controls (1/40 [3%]; P = .0002). Dense SEC was more frequently detected in CAs with plaque (38/98 [39%]) than in those without (43/166 [26%]; P = .0285), in CA plaque with ulcerative lesions (7/10 [70%]) than in those without (31/88 [35%]; P = .0325), in CA plaque with a thrombus (11/12 [92%]) than in those without (27/86 [31%]; P < .0001), and in CAs with severe stenosis (11/13 [85%]) than in those with mild stenosis (25/75 [33%]; P = .0005) and in those without stenosis (45/176 [26%]; P < .0001). CONCLUSIONS Dense SEC was frequently observed in CAs of patients with ICVD, especially in those with local atheromatous lesions, although the influence of systemic factors could not be excluded. Dense SEC within a CA may be a marker of ICVD.
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Affiliation(s)
- Hisao Onozuka
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
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Baroncini LAV, Pazin Filho A, Murta Junior LO, Martins AR, Ramos SG, Cherri J, Piccinato CE. Ultrasonic tissue characterization of vulnerable carotid plaque: correlation between videodensitometric method and histological examination. Cardiovasc Ultrasound 2006; 4:32. [PMID: 16914059 PMCID: PMC1562449 DOI: 10.1186/1476-7120-4-32] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2006] [Accepted: 08/17/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To establish the correlation between quantitative analysis based on B-mode ultrasound images of vulnerable carotid plaque and histological examination of the surgically removed plaque, on the basis of a videodensitometric digital texture characterization. METHODS Twenty-five patients (18 males, mean age 67 +/- 6.9 years) admitted for carotid endarterectomy for extracranial high-grade internal carotid artery stenosis (> or = 70% luminal narrowing) underwent to quantitative ultrasonic tissue characterization of carotid plaque before surgery. A computer software (Carotid Plaque Analysis Software) was developed to perform the videodensitometric analysis. The patients were divided into 2 groups according to symptomatology (group I, 15 symptomatic patients; and group II, 10 patients asymptomatic). Tissue specimens were analysed for lipid, fibromuscular tissue and calcium. RESULTS The first order statistic parameter mean gray level was able to distinguish the groups I and II (p = 0.04). The second order parameter energy also was able to distinguish the groups (p = 0,02). A histological correlation showed a tendency of mean gray level to have progressively greater values from specimens with < 50% to > 75% of fibrosis. CONCLUSION Videodensitometric computer analysis of scan images may be used to identify vulnerable and potentially unstable lipid-rich carotid plaques, which are less echogenic in density than stable or asymptomatic, more densely fibrotic plaques.
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Affiliation(s)
- Liz Andréa V Baroncini
- Department of Internal Medicine – Faculdade de Medicina de Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Antonio Pazin Filho
- Department of Internal Medicine – Faculdade de Medicina de Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Luiz O Murta Junior
- Department of Physics and Math – Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Antonio R Martins
- Department of Pharmacology – Faculdade de Medicina de Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Simone G Ramos
- Department of Pathology – Faculdade de Medicina de Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Jesualdo Cherri
- Department of Surgery and Anatomy – Faculdade de Medicina de Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Carlos E Piccinato
- Department of Surgery and Anatomy – Faculdade de Medicina de Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Kelley RE, Gonzalez-Toledo E. Stroke. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2005; 67:203-38. [PMID: 16291024 DOI: 10.1016/s0074-7742(05)67007-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Roger E Kelley
- Department of Neurology, Louisiana State University Health Sciences Center Shreveport, Louisiana 71103, USA
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Iwamoto T, Fukuda S, Shimizu S, Takasaki M. Long-Term Effects of Lipoprotein(a) on Carotid Atherosclerosis in Elderly Japanese. J Gerontol A Biol Sci Med Sci 2004; 59:62-7. [PMID: 14718487 DOI: 10.1093/gerona/59.1.m62] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Serum level of lipoprotein(a) [Lp(a)] is hereditarily constant throughout life within an individual, but the relationship between Lp(a) and atherosclerosis in elderly people is still controversial. METHODS Serum Lp(a) levels were studied in 208 elderly Japanese participants aged 80 years with a variety of diseases, using carotid ultrasonography (US), brain computerized tomography (CT), electrocardiography (ECG), and ankle brachial pressure index (ABPI). Carotid plaque lesions were divided into 3 types based on the US echogenicity assessed by a computer-assisted system: L type (hypoechoic plaque), H type (hyperechoic plaque), and M type (heterogeneous plaque). RESULTS The frequency of the L type and occlusion was significantly higher in the high Lp(a) group (n = 38) than in the normal Lp(a) group (n = 170). The mean height of the plaque was also greater in the high Lp(a) group than in the normal Lp(a) group. There was no difference in CT findings between the two groups. Myocardial ischemia on ECG and low ABPI (<0.9) were both frequently, but not significantly, seen in the high Lp(a) group. Among factors influencing US findings, multiple regression analysis showed that high Lp(a) correlated markedly to L type and cigarette smoking correlated to M type. CONCLUSIONS These findings indicate that, in Japanese elderly patients aged 80, serum Lp(a) strongly correlates with hypoechoic carotid lesions, which correspond histologically to lipid-rich, unstable atherosclerosis. This suggested that Lp(a) could promote the formation of atherosclerosis throughout life, and play a role as an independent risk factor for circulatory disturbance of the organ later in life.
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Affiliation(s)
- Toshihiko Iwamoto
- Department of Geriatric Medicine, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
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Muscari A, Martignani C, Bastagli L, Poggiopollini G, Tomassetti V, Baldini L, Cappelletti O, Boni P, Ravaglia G, Puddu P. A comparison of acute phase proteins and traditional risk factors as markers of combined plaque and intima-media thickness and plaque density in carotid and femoral arteries. Eur J Vasc Endovasc Surg 2003; 26:81-7. [PMID: 12819653 DOI: 10.1053/ejvs.2002.1879] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To test the hypothesis that some acute phase proteins may be better independent predictors of objective measures of arterial wall impairment than traditional risk factors. DESIGN Cross-sectional study. MATERIALS AND METHODS C-reactive protein (CRP), fibrinogen, C3 complement and traditional risk factors were measured in 288 men aged 55-64 years, randomly chosen from the local registry lists. By ultrasound assessment of the bifurcations of carotid and femoral arteries, maximum combined plaque/intima-media thickness (CPIMTmax) and mean plaque density (MPD, in a grey scale from 0 to 255) were also measured. RESULTS In multivariate analysis only traditional risk factors remained associated with the overall CPIMTmax: smoking (r = 0.35, p < 0.0001), cholesterol (r = 0.23, p = 0.0001), age (r = 0.22, p = 0.0002), glucose (r = 0.18, p = 0.002) and systolic blood pressure (r = 0.13, p = 0.02). However, with regard to carotid disease only, fibrinogen was the strongest covariate of CPIMT (r = 0.18, p = 0.002). The overall MPD was independently associated with CRP (r = 0.25, p = 0.0008), physical activity (r = 0.19, p = 0.009), triglycerides (r = -0.18, p = 0.02) and body mass index (r = 0.15, p = 0.04). CRP was mainly associated with femoral MPD, while triglycerides were the major (inverse) covariate of carotid MPD. CONCLUSIONS Traditional risk factors are the main determinants of CPIMTmax, although fibrinogen seems to play a role in carotids. CRP was associated with high density femoral plaques. Finally, no acute phase protein was independently associated with low density, potentially vulnerable, plaques.
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Affiliation(s)
- A Muscari
- Department of Internal Medicine, Cardioangiology, Hepatology, University of Bologna, Italy
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Iwamoto T, Shinozaki K, Kiuchi A, Umahara T, Takasaki M. Evaluation of B-mode ultrasonographic images of carotid lesions by computer analysis as compared with visual assessment. J Stroke Cerebrovasc Dis 2003; 12:59-65. [PMID: 17903906 DOI: 10.1053/jscd.2003.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2002] [Indexed: 11/11/2022] Open
Abstract
To establish an objective method for evaluating the characteristics of carotid artery lesions by B-mode ultrasonography, we compared the reproducibility of computer analysis with that of visual evaluation. Using two different models of ultrasonograph, we evaluated B-mode ultrasonographic images of 100 carotid artery lesions in a blinded fashion by computer analysis and visual evaluation, two times at a 1-month interval. Another 35 lesions were simultaneously imaged by the two models of ultrasonograph and were evaluated visually and by computer analysis to examine the correlation between results. For visual evaluation, carotid artery lesions were divided into the following 3 types based on texture and relative echogenicity as compared with that of adjacent muscle tissue: heterogeneous, hypoechoic, and hyperechoic. For computer analysis, images were computerized by means of a scanner (using Adobe Photoshop software). The echogenicity of all pixels included in the lesion and adjacent areas of muscular tissue was measured, and the lesion was classified into the following 3 types based on the shape of histograms of echogenicity: mixed-echoic (M), hyperechoic (H), and lucent (L). The reproducibility of the results derived by computer analysis had a significantly higher coincidence coefficient (kappa = 0.89) than those derived by visual evaluation (kappa =0.68). The coincidence coefficient (kappa) of the same lesions depicted by two different models of equipment was 0.77 for computer analysis as compared with only 0.32 for visual evaluation. These findings indicate that computer analysis of histogram shape and lesion echogenicity can improve intra-sonographer and inter-equipment reproducibility in the evaluation of lesion echogenicity and texture.
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Affiliation(s)
- Toshihiko Iwamoto
- From the Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan.
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Nagai Y, Matsumoto M, Metter EJ. The carotid artery as a noninvasive window for cardiovascular risk in apparently healthy individuals. ULTRASOUND IN MEDICINE & BIOLOGY 2002; 28:1231-1238. [PMID: 12467848 DOI: 10.1016/s0301-5629(02)00578-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Cardiovascular diseases are the leading cause of death and disability in industrialized countries. Because the etiologies are related to alteration of arterial wall properties, the noninvasive evaluation could help the presymptomatic diagnosis and potentially the prevention of future events. Ultrasound (US) is currently the only modality to image the arterial wall in real-time with sufficient resolution to allow for observation of its morphological, hemodynamic and elastic properties. Increased wall thickness and atheromatous plaques of carotid arteries are associated with cardiovascular risk factors and diseases. Also, carotid Doppler waveforms and wall elasticity may have associations with arterial health. Although evaluation of these arterial properties are currently limited to the research laboratories, most of such properties can be evaluated in the standard setting of carotid ultrasonography. This article reviews "potential" utilities of carotid US evaluation for cardiovascular risk assessment in apparently healthy individuals.
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Affiliation(s)
- Yoji Nagai
- Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
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Schminke U, Hilker L, Motsch L, Griewing B, Kessler C. Volumetric Assessment of Plaque Progression With 3-Dimensional Ultrasonography Under Statin Therapy. J Neuroimaging 2002. [DOI: 10.1111/j.1552-6569.2002.tb00128.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kobayashi E, Ono J, Hirai S, Yamakami I, Saeki N, Yamaura A. Detection of Unstable Plaques in Patients with Carotid Stenosis using B-Mode Ultrasonography. Interv Neuroradiol 2001; 6 Suppl 1:165-70. [PMID: 20667241 DOI: 10.1177/15910199000060s125] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2000] [Indexed: 11/15/2022] Open
Abstract
SUMMARY Distal embolism is a detrimental complication of stent placement for the carotid artery stenosis. To evaluate usefulness of B-mode ultrasonography (US) for the detection of unstable plaques in patients with carotid artery stenosis, we examined US in 46 arteries of 35 patients with carotid stenosis of > 30%. The echogenicity of 46 carotid plaques was hyperechoic in 20 plaques, hypoechoic in 15, and mixed-echoic in 11. The echogenicity of carotid plaques was correlated with severity of carotid stenosis, ipsilateral stroke or TIA, heart attack, and risk factors of systemic atherosclerosis. Hypoechoic plaques were associated with severe carotid stenosis and ipsilateral ischemic event. Mixed-echoic plaques had a high incidence of past history of heart attack. Hyperechoic plaques were less likely to associate with risk factors of systemic atherosclerosis. We developed a new method of echodensity analysis. Using a computer software, echodensity values of seven plaque components were determined by comparing US findings and pathology of surgical specimens. The echodensity value was defined as a relative value to the arterial lumen. The calcified part of plaques had the highest echodensity of 6.24 +/- 0.86 (mean +/- 2 S.D.); fibrosis or hyarynoid degeneration of 2.05 +/- 0.40, foamy histiocytes of 1.47 +/- 0.05, necrosis of 1.32 +/- 0.16, cholestelin clefts of 1.28 +/- 0.13, intraplaque hemorrhage of 1.02 +/- 0.09, and intraluminal thrombus of 1.27 +/- 0.07. Constructed from the echodensity value, an echo-densitometry color mapping of the carotid plaque illustrated the exact location and extent of plaque component. B-mode US of carotid plaques represents clinical characteristics relating distal embolism and systemic atherosclerosis. A new method of echodensity analysis and echo-densitometry color mapping of the carotid plaque is useful to detect unstable plaques in patients with carotid stenosis.
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Affiliation(s)
- E Kobayashi
- Department of Neurological Surgery, Chiba University School of Medicine; Chiba, Japan -
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Tegos TJ, Kalodiki E, Sabetai MM, Nicolaides AN. Stroke: pathogenesis, investigations, and prognosis--Part II of III. Angiology 2000; 51:885-94. [PMID: 11103857 DOI: 10.1177/000331970005101101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this review is to present the current knowledge regarding stroke. It will appear in three parts (in part I the epidemiology, clinical picture, and risk factors were discussed, while part III will consist of the management and rehabilitation). In the present part (II) the pathogenetic and pathophysiologic aspects of stroke are described. Regarding the investigations apart from the history and clinical examination and general investigations, the following specialized investigations and their role are discussed in detail: Computed tomography (CT), magnetic resonance imaging (MRI), xenon-blood-flow, positron emission tomography (PET), cerebral angiography, magnetic resonance angiography (MRA), ultrasonography, transcranial Doppler (TCD), echocardiography, Holter monitoring, and biopsies. In addition, taking into account the information from the above-cited modalities a prognosis for the final outcome is presented.
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Affiliation(s)
- T J Tegos
- Department of Vascular Surgery, St. Mary's Hospital, Imperial College of Science, Technology and Medicine, London, England.
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Lee DJ, Sigel B, Swami VK, Justin JR, Gahtan V, O'Brien SP, Dwyer-Joyce L, Feleppa EJ, Roberts AB, Berkowitz HD. Determination of carotid plaque risk by ultrasonic tissue characterization. ULTRASOUND IN MEDICINE & BIOLOGY 1998; 24:1291-1299. [PMID: 10385951 DOI: 10.1016/s0301-5629(98)00125-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This in vitro study investigated the ability of ultrasonic tissue characterization (UTC) to discriminate between plaques from asymptomatic and symptomatic patients and to compare UTC findings with quantitative measurements of plaque morphology. A total of 34 plaque specimens removed at carotid endarterectomy were scanned transversely at intervals of 1 mm, and compared to tissue cross-sections examined by optical microscopy employing computer-assisted planimetry. UTC was performed by spectral analysis of backscattered radiofrequency signals. The slope, intercept and total power parameters of the spectrum were evaluated. Discriminant analysis was used to compare the ability of the UTC spectral parameters and morphological constituents to correctly classify plaques according to their symptom group membership. UTC correctly classified 88.2% of the plaques. Thrombus was present in 93.9% of the plaques, and there was little difference in the morphological constituents of plaques from asymptomatic and symptomatic patients. Morphological constituents correctly classified 60.7% of the plaques. We conclude, in this preliminary study, that UTC can discriminate between carotid plaques from asymptomatic and symptomatic patients with moderate accuracy, despite a similarity in their morphological composition. UTC discrimination is not related to differences in the type or amount of morphological constituents in the plaques.
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Affiliation(s)
- D J Lee
- Department of Surgery, Allegheny University of the Health Sciences (AUHS), Philadelphia, PA, USA
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Montauban van Swijndregt AD, Elbers HR, Moll FL, de Letter J, Ackerstaff RG. Ultrasonographic characterization of carotid plaques. ULTRASOUND IN MEDICINE & BIOLOGY 1998; 24:489-493. [PMID: 9651958 DOI: 10.1016/s0301-5629(98)00005-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The composition of atherosclerotic plaques in the carotid artery is assumed to be related to the development of neurological symptoms. The echo patterns produced by B-mode ultrasound may be of use in the assessment of the plaques' composition. It is suggested that fibrotic and "stable" plaques are more echogenic than lipid/hemorrhagic and echolucent or "unstable" plaques. B-mode ultrasound procedures were performed 1 day prior to surgery on 46 consecutive endarterectomies. Two observers assessed the plaques according to their echo pattern and echogenicity and sorted them into three categories: 1) predominantly echolucent, 2) heterogeneous, and 3) predominantly echogenic. The intraobserver agreement was moderate (kappa = 0.44) and the interobserver agreement low (kappa = 0.38). Furthermore, subjective categorization of plaque types resulted in type 1 plaques being as fibrotic as type 2 or 3 plaques. We conclude that B-mode ultrasound and subsequent subjective categorization of atherosclerotic plaques cannot adequately determine the volume of fibrosis or lipids within the plaque.
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El-Barghouti NM. The value of studying carotid plaque morphology. J Stroke Cerebrovasc Dis 1998; 7:105-8. [PMID: 17895066 DOI: 10.1016/s1052-3057(98)80136-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/1997] [Accepted: 07/24/1997] [Indexed: 10/24/2022] Open
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